322例非小细胞肺癌骨转移临床特点及治疗的回顾性分析

Abstract

背景与目的骨是非小细胞肺癌最常见转移部位之一，可引起疼痛病理性骨折等，严重影响患者生活质量。本研究探讨非小细胞肺癌骨转移的临床特点及预后因素。方法回顾性分析我科近5年收治的600例非小细胞肺癌患者，单光子计算机断层扫描（emission computed tomography, ECT）作为筛查方法，计算机断层扫描（com-puted tomography, CT）/磁共振成像（magnetic resonance imaging, MRI）/X线或病理学诊断作为骨转移的确诊方法。结果肺腺癌发生骨转移的比率最高，脊柱、骨盆、股骨等为骨转移高发部位。ECT显示3个浓聚灶及以上者，行CT/MRI/X线可以证实骨转移，确诊骨转移的几率远远高于ECT显示1个-2个浓聚灶的患者[80.6%（203/252） vs 50.79%（32/63）, P<0.001]。出现骨转移后未发生骨相关事件（skeletal related events, SRE）的患者生存期长于发生SRE者，1年生存率和中位生存期分别为44.75%、14.74个月vs 36.17%、12.25个月（P=0.022）。经Cox多因素分析，病理组织学诊断为非腺癌、骨转移病灶数少于3个，单纯骨转移为有益于生存期的预后因素。结论 ECT异常浓聚灶的数目与骨转移影像学的确诊有关。病理组织学非腺癌、骨转移病灶数少于3个、单纯骨转移是非小细胞肺癌骨转移的独立预后因素。

Background and objective Bone metastases are the most common metastases of the non-small cell lung cancer (NSCLC). It can lead to bone ache and pathology fracture, deteriorate the quality of life. Methods We retrospec-tively investigated the characteristics, diagnosis and prognosis factors of bone metastases in NSCLC. All of the 600 patients are from department of thoracic oncology in recently 5 years. Emission computed tomography (ECT) was used to screen the bone metastases and the diagnosis of bone metastases was conifrmed by computed tomography (CT)/magnetic resonance imaging (MRI)/X-ray or pathology. Results Among the total 322 bone metastases patients, subtype of adenocarcinoma had the most opportunity to occur bone metastases, and we found that vertebrae, pelvis and femora et al were the most frequently involved metastases sites. Patients who had more than 3 high 18F-FDG uptake sites of ECT, could be conifrmed bone metasta-ses by CT/MRI/X-ray than those with 1-2 high 18F-FDG uptake sites [80.6%(203/252) vs 50.79%(32/63), P<0.001]. hTe patients with bone metastases who had non-SRE had longer survival than that of SRE [1-yr survival 44.75%(non-SRE) vs 36.17%(SRE);median survival 14.74 mo (non-SRE) vs 12.25 mo (SRE)]. Multivariables analysis showed the pathology were non-adnocarcinoma, bone metastases less than 3 sites and bone metastases without other organs metastases would have good prognosis. Conclusion hTere were relations between the numbers of abnormal dense sites of ECT and the diagnosis of skeletal metastases, non-adnocarcinoma bone metastases less than 3 sites and bone metastases without other organs metastases were the independent prognosis factors.